Schizophrenia Care for Adults in Hospitals INFORMATION AND DATA BRIEF: Why this quality standard is needed Let’s make our health system healthier www.HQOntario.ca

What Are Quality Standards Concise sets of easy-to-understand statements outlining what care should look like for people living with certain conditions and being cared for in specific settings Based on the best available evidence Designed for health care providers to know what care they should be offering To also help patients, residents, families and caregivers know what to ask for in their care www.HQOntario.ca

The Purpose of this Brief Schizophrenia affects approximately 1% of the Canadian population, which translates to more than 100,000 people in Ontario who live with this condition [1] This brief provides information and data demonstrating why a quality standard is needed for adults with schizophrenia Specifically, it provides performance data on indicators that reflect the care received by adults with schizophrenia in hospital settings [1] Public Health Agency of Canada: http://www.phac-aspc.gc.ca/publicat/miic-mmac/chap_3-eng.php www.HQOntario.ca

The Purpose of this Brief The data demonstrate that care for adults living with schizophrenia needs to be improved That is why this quality standard has been created: To inform clinicians and organizations on what high-quality health care for people living with this condition should look like To help clinicians and organizations assess the quality of care they are delivering, so they can identify gaps and areas for improvement www.HQOntario.ca

How We Look at the Data When available, the information presented reflects different perspectives Provincial results over time offer a broad overall system view Results by LHIN region highlight some of the local differences The distribution of the results across facilities provides some points of reference to hospitals www.HQOntario.ca

The Data www.HQOntario.ca

Some Context Because the quality standard aims at improving health outcomes among people living with schizophrenia in hospitals, a set of indicators has been selected to measure the impact of the schizophrenia quality standard as a whole. We examine the following as overall measures of performance: Percentage of patients who were readmitted to hospital for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia Percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia www.HQOntario.ca

In 2014, 13% of patients were readmitted to hospital for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia, and this proportion has not changed over the last eight years. Percentage of patients who were readmitted to hospital for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia, in Ontario, 2006 to 2014 www.HQOntario.ca

The percentage of patients who were readmitted to hospital for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia ranged from 9.1% to 16.2% across LHIN regions. Percentage of patients who were readmitted to hospital for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia, in Ontario, by LHIN region, three-year average for 2012 to 2014 www.HQOntario.ca

Across facilities in Ontario, the percentage of patients who were readmitted for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia ranged from 0% to 29.5%. Percentage of patients who were readmitted to hospital for a mental health or addictions condition within 30 days of a previous hospital discharge for schizophrenia, in Ontario, by facility, three-year average for 2012 to 2014 www.HQOntario.ca

11.8% of patients revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia, and this proportion has not improved over the last eight years. Percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia, in Ontario, 2006 to 2014 www.HQOntario.ca

The percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia ranged from 9.3% to 16.6% across LHIN regions. Percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia, in Ontario, by LHIN region, three-year average for 2012 to 2014 www.HQOntario.ca

Across facilities in Ontario, the percentage of patients who visited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia ranged from 4.9% to 26.3%. Percentage of patients who revisited the emergency department for a mental health or addictions condition within 30 days of a previous emergency department visit for schizophrenia, in Ontario, by facility, three-year average for 2012 to 2014 www.HQOntario.ca

Some Context Because the quality standard recommends that adults with a primary diagnosis of schizophrenia who are discharged from an inpatient setting have a follow-up appointment within seven days, we examined the percentage of patients who had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia. www.HQOntario.ca

28.2% of patients had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia, and this has not improved over the last eight years. Percentage of patients who had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia, in Ontario, 2006 to 2014 www.HQOntario.ca

The percentage of patients who had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia varied across LHIN regions from 15.0% to 41.3%. Percentage of patients who had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia, in Ontario, by LHIN region, three-year average for 2012 to 2014 www.HQOntario.ca

Across facilities in Ontario, the percentage of patients who had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia ranged from 8.4% to 50.0%. Percentage of patients who had contact with a family doctor or a psychiatrist within seven days of a previous hospital discharge for schizophrenia, in Ontario, by facility, three-year average for 2012 to 2014 www.HQOntario.ca

Additional Resources This Information Brief is intended to support the Schizophrenia Quality Standard, which can be found in full HERE www.HQOntario.ca

Acknowledgements Health Quality Ontario thanks Paul Kurdyak (Institute for Clinical and Evaluative Sciences (ICES) and Centre for Addiction and Mental Health (CAMH)) for his contributions to this publication. Health Quality Ontario would also like to thank Abigail Amartey, Jenny Gatov, Julie Yang and Maria Chiu of the MHASEF (Mental Health and Addictions Scorecard and Evaluation Framework) Research Team. The MHASEF Research Team is supported by a grant from the Ontario Ministry of Health and Long-Term Care. www.HQOntario.ca

Acknowledgements Notes: Some of the indicators in this report were derived using health administrative datasets from Ontario. These datasets were linked using unique encoded identifiers and analyzed at ICES. www.HQOntario.ca

www.HQOntario.ca FOLLOW@HQOntario